Intravascular volume optimisation during repair of proximal femoral fracture
Authors: K. Toh, W J Fawcett, M. J Parker, D. Buggy, G. Fitzpatrick, M. Singer, S. Sinclair
Journal: BMJ (1998)

# Intravascular volume was depleted perioperatively in control group {#article-title-2} EDITOR—In their study investigating intravascular volume optimisation and proximal femoral fracture, Sinclair et al have a different approach to fluid replacement between the two groups studied.1 The control group received only a median volume of 1000 ml of crystalloid (presumably Hartmann's or 0.9% saline solution) peroperatively. As only about a quarter of this solution is retained intravascularly, these patients effectively had a depleted intravascular volume perioperatively. In contrast, the protocol group received a median of 750 ml of colloid as well as 725 ml of crystalloid, giving intravascular fluid replacement of nearly 1 litre. The preoperative dextrose-saline maintenance fluids would have had minimal effect on the intravascular volume: only 15% of such a solution is retained within the intravascular compartment. This study merely shows that patients who have not received fluid or who have fluid depletion have a higher rate of complications, which is not a surprising or new finding. A control group should be recognisable as such; if the control group has been deprived of fluid then this will magnify any benefits in the protocol group. We suggest that if adequate preoperative intravascular fluids, and not just dextrose-saline maintenance fluids, had been given to all patients, replacing the blood loss associated with femoral fractures (often in excess of 1 litre2), then the differences between the groups would have been much less. A study comparing a group in whom optimisation is used with a group given sufficient fluid would be of much greater importance and would show the benefits of optimisation more clearly. 1. 1.↵1. Sinclair S, 2. James S, 3. Singer M . Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial. BMJ 1997;315:909-912. (11 October.) [OpenUrl][1][Abstract/FREE Full Text][2] 2. 2.↵1. Willet KM, 2. Dorrell H, 3. Kelly P . ABC of major trauma: Management of limb injuries. BMJ 1990;301:229-233. # Differences in outcome were probably due to chance {#article-title-5} EDITOR—Sinclair et al's randomised controlled trial of intraoperative intravascular volume optimisation in patients with proximal femoral fracture raises important issues regarding the preoperative administration of fluid to … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DSinclair%26rft.auinit1%253DS.%26rft.volume%253D315%26rft.issue%253D7113%26rft.spage%253D909%26rft.epage%253D912%26rft.atitle%253DIntraoperative%2Bintravascular%2Bvolume%2Boptimisation%2Band%2Blength%2Bof%2Bhospital%2Bstay%2Bafter%2Brepair%2Bof%2Bproximal%2Bfemoral%2Bfracture%253A%2Brandomised%2Bcontrolled%2Btrial%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.315.7113.909%26rft_id%253Dinfo%253Apmid%252F9361539%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=315/7113/909&atom=%2Fbmj%2F316%2F7137%2F1089.2.atom